Provider Demographics
NPI:1447739743
Name:MOUNTAIN AREA BODY-PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:MOUNTAIN AREA BODY-PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASSERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-337-2716
Mailing Address - Street 1:2 S MAIN ST STE 28
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8485
Mailing Address - Country:US
Mailing Address - Phone:828-337-2716
Mailing Address - Fax:
Practice Address - Street 1:2 S MAIN ST STE 28
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8485
Practice Address - Country:US
Practice Address - Phone:828-337-2716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty